| NPI | 1710009733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1166119) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2013-03-27 |